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BUFFALO, N.Y. – A panel of tobacco researchers that guides
180 World Health Organization countries on developing constructive
new regulations for tobacco products recently advised the group to
consider a “global nicotine reduction strategy.”

This strategy would require that very low nicotine cigarettes
could be the only cigarettes sold legally. These cigarettes would
have so little nicotine in the tobacco that they would not create
an addiction to cigarettes. This advice also warned that only
countries with extensive tobacco-control programs should try
this.

But the scientific evidence to date doesn’t support such a
recommendation at this time, even for countries with very strong
tobacco control programs, a University at Buffalo researcher writes
in a new paper published online July 1 in the journal Tobacco
Control.

Lynn
T. Kozlowski, a professor of community health and health
behavior in UB’s School of Public Health and Health
Professions, cautions that much more needs to be known about the
effects of such an untested prohibition or ban of traditional
cigarettes before any WHO nations implement the recommendation.

“Countries need to appreciate that such a ban or
prohibition of traditional cigarettes has not yet been assessed
anywhere in a community with a representative sample that includes
individuals with mental health or other substance abuse
issues,” says Kozlowski, PhD.

The WHO Framework Convention on Tobacco Control in 2003 was the
first international treaty created by the WHO. Some 180 countries
— including Afghanistan, Austria, Bangladesh, Belize, France,
Greece, Nigeria, Spain, Sweden and Zimbabwe — have ratified
the treaty. WHO has a panel of tobacco researchers, known as
“TobReg,” that offers recommendations to members of the
Framework Convention.

In addition to advising that members sell only low-nicotine
cigarettes, TobReg also advises that it would be important to have
alternative, safer forms of nicotine products available.

However, Kozlowski says, the reality in the world right now is
that many countries ban less-harmful products. For example, Canada
prohibits nicotine-containing e-cigarettes, while the European
Union (outside of Sweden) bans snus, a low-nitrosamine
Swedish-style oral smokeless tobacco. Both products are estimated
to be more than 90 percent less harmful than cigarettes.

“The so-far very preliminary, suggestive research in
non-representative samples does not yet justify TobReg’s
qualified recommendations for global deployment of such product
regulations,” said Kozlowski. “The effects of
prohibitions on traditional cigarettes by means of mandatory
low-nicotine cigarettes need to be assessed in better samples and
in real-world communities before being disseminated.”

Think of it this way, Kozlowski says: “Imagine a coffee
lover who likes caffeine in his coffee. If only decaffeinated
coffee — which has a little caffeine in it — could be
legally sold, the aforementioned coffee drinker would perceive a
prohibition on the product he prefers, even though decaffeinated
coffee was still available.”

Banning a desired product could create contraband markets, as
well as costs associated with enforcing the ban, Kozlowski points
out.

Moreover, Kozlowski says, the scientific evidence on the
effectiveness of reduced-nicotine cigarettes “shows quite
small effects of doubtful clinical significance” and has been
conducted on samples that aren’t representative of smokers
overall.

“Evidence of very small good effects on a few smokers
should not be used to justify a disruptive and coercive cigarette
prohibition,” he says.

“The recommendations are not warranted until long-term
studies on representative samples of smokers show this is good for
public health overall,” he said. “A country needs to
try this and see what happens before others follow suit. Having an
optional low-nicotine cigarette that some smokers might want to use
is very different than making such cigarettes the only legal
cigarettes. When these low-nicotine cigarettes have been on the
market and heavily promoted, they have proven to be commercial
failures.”

Reduced-nicotine cigarettes would also represent a far different
tobacco-control strategy than previous ideas, such as plain
packaging and graphic warning labels, which, Kozlowski notes,
don’t change the product itself.

“On balance, it is very hard to see that we are close to
having an evidence base that would support any government to embark
upon implementation of a mandatory regulation for all their smokers
— no matter how advanced their tobacco-control
programming,” Kozlowski writes in the paper.